Research| Volume 38, ISSUE 2, P305-311, April 2023

The Effect of an Educational Intervention on Nurses’ Knowledge, Perception, and Use of Nursing Presence in the Perioperative Setting

Published:December 06, 2022DOI:



      Explore the effect of a nursing presence educational intervention on nurse circulators’ perceptions, knowledge, and use of nursing presence with patients undergoing surgical procedures.


      One group, pretest-posttest design.


      Nursing presence is an intentional-reflective way of being with patients that was operationalized using four domains (Attention-to-Environment, Interaction Quality, Focus-of-Energy, and Active Engagement). Data collection involved observations of participants in practice and completion of surveys to examine 34 randomly selected nurse circulators’ knowledge, perception, and use of nursing presence before and after participating in a nursing presence educational intervention. Dependent t tests and McNemar tests were used to examine relationships between the independent and three dependent variables – knowledge, perceptions, and use of nursing presence.


      The educational intervention significantly enhanced participants’ nursing presence knowledge, but not perceptions, which were very high at baseline. Participants’ significantly increased their use of 3 of 4 nursing presence domains with the exception of the Attention-to-Environment domain, which is related to promoting a healing environment.


      Lack of attention to promoting a healing environment by the surgical team created a barrier to circulators’ ability to successfully use all four nursing presence domains. Embracing nursing presence as a practice framework involves cooperation from the surgical team and a shift in perioperative environment from a chaotic to healing one.


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      1. Surgeries in Hospital-Based Ambulatory Surgery and Hospital Inpatient Settings, 2014. Statistical Brief #223. Agency foHealthcare Quality and Safety website. Updated July 2020. Accessed April 5, 2022.

      2. AORN Position Statement on Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure Association of periOperative Registered Nurses (AORN) position statement. AORN Inc. website. Accessed April 4, 2022.

        • Katz JD.
        Noise in the operating room.
        Anesthesiology. 2014; 121: 894-898
        • Ginsberg SH
        • Pantin E
        • Kraidin J
        • Solina A
        • Panjwani S
        • Yang G.
        Noise levels in modern operating rooms during surgery.
        J Cardiothorac Vasc Anesth. 2013; 27: 528-530
        • Göras C
        • Olin K
        • Unbeck M
        • et al.
        Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study.
        BMJ Open. 2019; 9e026410
        • Mohammadipour F
        • Atashzadeh-Shoorideh F
        • Parvizy S
        • Hosseini M.
        An explanatory study on the concept of nursing presence from the perspective of patients admitted to hospitals.
        J Clin Nurs. 2017; 26: 4313-4324
        • Ellison DL
        • Meyer CK.
        Presence and therapeutic listening.
        Nurs Clin North Am. 2020; 55: 457-465
        • Easter A.
        Construct analysis of four modes of being present.
        J Holist Nurs. 2000; 18: 362-377
        • Presence
        Lindquist R Tracy MF Snyder M Complementary and Alternative Therapies in Nursing. 8th ed. Springer, 2018: 19-28
        • Osterman P
        • Schwartz-Barcott D.
        Presence: four ways of being there.
        Nurs Forum. 1996; 31: 23-29
        • Paterson JG
        • Zderad LT
        Humanistic Nursing: Meta-Theoretical Essays on Practice.
        John Wiley, 2007 (Accessed November 1, 2021)
        • Finfgeld-Connett D.
        Meta-synthesis of presence in nursing.
        JAN. 2006; 55: 708-714
        • Kostovich CT
        • Clementi PS.
        Nursing presence: Putting the art of nursing back into hospital orientation.
        J Nurses Prof Dev. 2014; 30: 70-75
        • Zyblock DM.
        Nursing presence in contemporary nursing practice.
        Nurs Forum. 2010; 45: 121-124
        • Horn G
        • D'Angelo D
        Does the coping assessment for laboring moms (CALM) scale enhance perception of nursing presence?.
        Nurs Womens Health. 2017; 21: 360-371
        • Pengue S
        • Kearney G
        The effect of nursing presence on patient satisfaction.
        Nurs Manag. 2015; 46: 38-44
        • Mohammadipour F
        • Atashzadeh-Shoorideh F
        • Parvizy S
        • Hosseini M.
        Concept development of “Nursing Presence”: application of Schwartz-Barcott and Kim's hybrid model.
        Asian Nurs Res. 2017; 11: 19-29
      3. Noise and hearing loss prevention: Facts and statistics: The National Institute for Occupational Safety and Health (NIOSH) website. Updated February 6, 2018. Accessed November 12, 2021.

        • Liu EH
        • Tan S.
        Patients’ perception of sound levels in the surgical suite.
        J Clin Anesth. 2000; 12: 298-302